Thanks to mounting regulatory requirements, declining reimbursement rates, and increasing patient financial responsibilities, health care providers are facing more challenges to their bottom lines than ever before. In this increasingly difficult environment, revenue cycle optimization has risen in prominence.
Unfortunately, many providers quickly find out that adjusting financial operations on the fly can be the greatest challenge of all. Some organizations don’t know where to begin, others struggle to incorporate new revenue strategies into other ongoing priorities.
To help you improve efficiency and boost cash flow, Quammen Health Care Consultants recommends three highly effective revenue cycle optimization strategies.
Outsource Denial Management
A recent NextGen study found that only 15% of providers believed they had “excellent” denial resolution and follow-up practices. Only 53% take advantage of the potential extra revenue available from claim resubmission. Why are so many organizations falling behind in denial management?
An optimal process would involve investigating reasons for denial, resolving issues, and resubmitting the claim in a timely fashion. It would also include evaluating data and taking proactive measures to limit future denials. This is an extremely resource-intensive endeavor that can be too much to handle in-house.
According to Marc Holt, a representative of Paragon and an expert in Minneapolis business IT, “more and more providers are choosing to outsource denial management to a consulting partner with the right expertise and resources. It’s easy to see why. Outsourcing helps organizations by reducing future denials and boosting revenue from effective claim resubmissions.”
Automate Eligibility Verification and Claim Scrubbing
Automation gives organizations the tools needed to achieve some key goals in revenue cycle management (RCM), including reducing missed appointments, accurately verifying insurance, limiting denials, and ensuring precise coding.
Automated eligibility verification tools are just one example of the optimizing power of technology. They allow physicians to verify insurance coverage in minutes — reducing eligibility denials and leaving more resources to focus on staff workflow.
Organizations that embrace claims scrubbing automation technology can achieve a first pass clean rate of up to 90-95 percent!
Improve Patient Payment Collection
As patients assume more of the financial responsibility for health services, providers must be able to respond with appropriate strategies. If you’re too focused on the payer side of your revenue, you are missing some key opportunities for optimization.
What strategies will help you keep patient payment collection running smoothly despite high copays and deductibles?
– A credit card on file program involves securely storing a patient’s credit card so it can be charged for automatic payments for co-pays, deductibles, non-covered care, or any remaining balance after insurance has been processed.
– Offer upfront cost estimates and clarify final statements
– Offer more payment options
Your Revenue Cycle Management Partner!
Revenue cycle optimization strategies are never easy to implement, especially for providers dealing with multiple priorities and limited resources.
Quammen Health Care Consultants has all the tools and knowledge you need to help your organization maximize its cash flow. Contact us today to learn more about how you can benefit from our revenue cycle management services!